english.prescrire.org > Spotlight > Archives : 2011 > Cancer and end of life: sometimes it is in the patient’s best interest not to treat

Spotlight: Archives

Every month, the subjects in Prescrire’s Spotlight.

2011 : 1 | 30 | 60

Cancer and end of life: sometimes it is in the patient’s best interest not to treat

Knowing when not to treat with cytotoxic chemotherapy is sometimes the best solution for patients.

An original British study draws on data relating to the treatments, adverse effects and deaths of 600 cancer patients given cytotoxic anticancer drugs and whose death occurred in the 30 days following the chemotherapy treatment.

The vast majority of patients had been treated without curative aim. The cytotoxic chemotherapy appears to have caused or accelerated the death of around a quarter of the patients.

40% of the patients experienced a severe adverse effect, sometimes resulting in admission to hospital. Nearly a quarter of the patients were in a poor general condition at the time of commencing the treatment.

In short, when a cancer is at an advanced stage, a cytotoxic chemotherapy treatment sometimes causes severe adverse effects which will affect the patient’s quality of life, and even lead to or accelerate their death.

Ideally, the difficult decision whether or not to treat should be taken collectively by the doctors, the nursing team and the patient, after discussion of all the options. However, the decision to treat is sometimes taken so as “to do something”, and “not abandon the patient” on the initiative of the doctor, or at the request of the patient or their entourage.

This study shows that knowing when not to treat is sometimes the best solution for the patient. This is a useful piece of information that can help healthcare professionals make the best decision possible.

©Prescrire 1 June 2011

"To treat or not to treat cancer patients with chemotherapy at the end of life?" Prescrire Int 2011; 20 (117): 152-153. (Pdf, subscribers only)
Download the full review.
Pdf, subscribers only